This invention relates to neurosurgical apparatus generally, and more particularly, to an improved apparatus for supporting an upper torso and head of a patient.
With current medical practices, it is common for a patient to undergo a diagnostic scanning procedure, which is normally performed in a separate suite containing the scanning machine and dedicated to scanning procedures. The scanning machine may be a CT, MRI, or other scanning device. Thereafter, the scan data is utilized in a surgical planning process, which conventionally takes place at a location, for example, an office or an operating room. In some surgical procedures, the scanning data is utilized with a system for post processing the scan data acquired during imaging. Further, the imaging system may be located in a surgical suite, and the surgical planning performed before and during a surgical procedure utilizing the imaging system and scan data.
During the scanning procedure, the patient must maintain a perfectly still and motionless posture, and while most often, the patient simply lies on a scanning support table, in some situations, the patient may be supported in the desired scanning position with pads, straps or other supports. Further, the support on which the patient rests is normally radiolucent, that is, transparent to the scanning device, so that the support does not compromise the utility of the scanned image. Further, the patient support used for scanning normally translates with respect to the imaging device. Translation of the patient support permits the patient to be moved into the scanning field or zone of the scanning machine.
After the scanning process is completed, often the patient is then moved to an operating room which requires either that the patient walk, or be carried, for example, by transferring the patient from the scanning table to an operating table. Alternatively, as illustrated in U.S. Pat. No. 5,475,884, the patient may be supported on a portable support plate, which is easily moved between the scanning table and the operating table. The scan data is often used in a post processing imaging system for surgical planning purposes both prior to and during surgery. If during or after a surgical process, it is desired to scan a patient again, the patient must be moved from the operating room to the scanning suite, transferred to and from the operating table to the scanning table, and after scanning, transferred back to the operating table and returned to the operating room. The above process is cumbersome, time consuming and potentially risky for the patient.
Some newer scanning machines are substantially reduced in size. One such machine is shown in FIGS. 2 and 3 of U.S. Pat. No. 5,499,415, which show an annular-shaped scanner mounted on a wheel-supported frame, to enable the scanner to be used at multiple sites. Consequently, such scanning machines do not require their own suite or room, but instead, they may be used within the operating suite itself. Thus, in an operating room, the patient may be scanned; the surgical planning performed; an operative procedure executed; and the patient scanned again to determine the current status of the operative procedure. Based on the new scanned images obtained from the one or more xe2x80x9cinteroperativexe2x80x9d scans, the operative procedure can be continued and the above process repeated as necessary.
A limitation of the current state-of-the-art is that the posture of the patient during the scanning process is often different from the patient""s posture during surgery. If a patient is positioned in one posture on a scanning table during the scanning process, and then is moved to an operating table, that motion of the patient may cause the position of the target to change with respect to the body surface. During surgery, this problem is compounded by tissue shifts attendant to the opening of body cavities, removal of body fluid or tissues and tissue retractions. Thus, while such motion may be small, any motion of the target will reduce or compromise the utility of the preoperative scan data.
The solution to these problems is to scan the patient in the operating room during surgery while the patient is maintained in the surgical posture, and further, to make successive interoperative scans, as necessary, while still holding the patient in the same surgical posture.
While current scanning tables are radiolucent and provide a translation to move the patient into the scanning machine, such scanning tables do not have the accessories required to attach, support and stabilize surgical instrumentation and to properly support the patient""s body in the desired surgical posture. Further, while surgical, or operating, tables contain numerous accessories and couplings to which surgical instrumentation may be attached and supported, most operating tables are not compatible with scanning instrumentation. Thus, as presently known, scanning tables cannot be used as operating tables, and generally, operating tables are inappropriate for use as scanning tables.
It is an object of this invention to overcome the above-described limitations in the prior art, by facilitating the function of supporting a patient in a desired position in a manner which readily accommodates successive surgical and scanning procedures as well as interoperative scans. Further the invention fulfills a need to improve and simplify surgical tooling used to support a patient during such procedures.
The present invention provides an improved radiolucent surgical table extension assembly for mounting a skull clamp to the table extension. The improved radiolucent surgical table extension assembly of the present invention has fewer parts, is simpler to use, is more flexible and is generally less expensive and more reliable than known devices. The improved radiolucent surgical table extension assembly of the present invention is especially useful for mounting a head support, for example, a radiolucent skull clamp, to the surgical table extension and permits neurological surgical procedures to be performed more efficiently and with less stress.
In accordance with the principles of the present invention and the described embodiments, the invention is a radiolucent surgical table extension assembly for use in combination with a scanning machine having an enclosed scanning zone. The invention includes a radiolucent support member having a proximal end adapted to be removably attached to one end of a table in cantilever fashion. The radiolucent support member has a rigidity sufficient to support an upper torso and head of a patient. The table and the radiolucent support member are movable relative to the scanning machine to locate the radiolucent support member and the head of the patient within the scanning zone. A radiolucent mounting structure is connected to the radiolucent support member, and a radiolucent head support is attached to the radiolucent mounting structure for supporting the head of the patient. The radiolucent head support has an opening extending therethrough. The opening receives a locking clamp for attaching the radiolucent head support to the radiolucent mounting structure.
In one aspect of this embodiment, the mounting structure permits the head support to be moved through linear and rotary motions with respect to the support member. In another aspect of this embodiment, the head support is a radiolucent skull clamp having two frame members, wherein each of the members has first legs extending adjacent each other. The first legs have openings extending therethrough for receiving the locking clamp to attach the radiolucent skull clamp to the radiolucent mounting structure.
In another embodiment of the invention, the skull clamp includes a first frame member having an angular positioning mechanism mounted at one end of the first frame member with a pin holding member rotatably mounted to the angular positioning mechanism. A first arm forming an opposite end of the first frame member, the first arm has an opening extending therethrough. A second frame member has a pin holder on one end thereof and a first arm forming an opposite end of the second frame member. The first arm has an opening extending therethrough, and the first arms of the first and second frame members are positioned with respect to each other so that the first and second frame members form a generally C-shaped skull clamp. A clamp extends through the openings in the first arms of the first and second frame members and is adapted to removably connect the skull clamp to a supporting structure.
In one aspect of this second embodiment, the clamp is a knob attached to a threaded shaft; the opening in the first arm of the first frame member is a clearance hole for receiving the shaft; and the opening in the first arm of the second frame member is a clearance slot for receiving the shaft.
In a further embodiment, the present invention includes a method of mounting a radiolucent skull clamp having a connector to a support having a mating connector. The method first holds the connector of the radiolucent skull clamp against the connector of the support in a desired orientation. A clamp shaft is then inserted through clearance holes in both the first and second frame members of the skull clamp, and the clamp shaft is then secured to the support, thereby mounting the skull clamp to the support.
The improved radiolucent surgical table extension assembly of the present invention utilizes a radiolucent skull clamp with clearance openings extending through the base of the adjacent lower arms of the clamp with the movable lower arm having a clearance slot, thereby permitting the movable lower arm to move through its full range of motion without interfering with a clamp shaft extending through the clearance openings and mounting the skull clamp to the table extension.
Various additional advantages, objects and features of the invention will become more readily apparent to those of ordinary skill in the art upon consideration of the following detailed description of the presently described embodiments taken in conjunction with the accompanying drawings.